Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List

Kim, Woojin; Biggins, Scott W.; Kremers, Walter K.; Wiesner, Russell H.; Kamath, Patrick S.; Benson, Joanne T.; Edwards, Erik; Therneau, Terry M.

doi:10.1056/nejmoa0801209

Cited by 1,212 publications

(1,139 citation statements)

References 38 publications

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“…Data collected regarding the initial hospitalization and readmission included demographic characteristics, cause of cirrhosis, length of hospital stay, comorbidities, laboratory values (at admission and discharge dates), standardized costs, and the primary reason for admission. The MELD score and the MELD plus serum sodium (MELD‐Na) score were calculated within 48 hours of admission and within 48 hours before hospital discharge by applying standard formulas 8, 9, 10…”

Section: Methodsmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30‐day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30‐day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30‐day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30‐day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198)

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Section: Methodsmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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“…Serum sodium measurements were not included in the final survival model because of a well-known interaction between renal function, ascites, and sodium. 13,14 Serum sodium is also influenced significantly by RRT and fluid status and was therefore not included in the post-transplant survival analysis. 15 All statistical tests were 2-sided, and the level of significance of type 1 error was assumed to be less than or equal to 0.05.…”

Section: Methodsmentioning

confidence: 99%

Pretransplant predictors of recovery of renal function after liver transplantation

et al. 2010

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The Model for End-Stage Liver Disease system has given priority on the liver transplant waiting list to candidates with renal failure. This study determined the predictors of spontaneous recovery of renal function after transplantation in 1041 liver transplant recipients on renal replacement therapy (RRT) at the time of transplant (from February 2002 to January 2007). Data from these patients were obtained from the US Organ Procurement and Transplantation Network and US Renal Data System databases. Univariate and multivariate survival models were constructed along with multivariate logistic regression models to find independent predictors of spontaneous renal recovery. Seven hundred seven recipients (67.9%) had spontaneous recovery of renal function after liver transplantation. Those recovering spontaneously had a significantly shorter course of RRT in the pretransplant time period (15.6 versus 36.6 days, P < 0.001). Recovery of renal function was observed in 70.8% and 11.5% of recipients on RRT for less than 30 days and more than 90 days, respectively. Other statistically significant pretransplant variables independently associated with recovery of renal function included recipient age, recipient pretransplant diabetes, and donor age. In conclusion, the duration of pretransplant RRT is highly predictive of spontaneous renal recovery post-transplant. Liver transplant candidates requiring less than 30 days of pretransplant RRT are likely to spontaneously recover renal function after liver transplantation, whereas those on RRT for more than 90 days are not. In the era of Model for End-Stage Liver Disease (MELD)-based liver allocation, there has been a preference for organ allocation to those patients with renal dysfunction, with the result that more than 30% of patients awaiting liver transplantation have decreased renal function, including a substantial number that require renal replacement therapy (RRT). 1,2 This has coincided with a rise in combined liver-kidney transplantation (CLKT) in the past 7 years. Impaired renal function at the time of transplantation has been shown to have a detrimental impact on morbidity and mortality after liver transplantation. 2,3 Despite imprecise methods for measuring renal dysfunction, 4 it is clear that the pretransplant degree of renal insufficiency has a major impact on post-transplant survival. 5 Specifically, the length of pretransplant renal dysfunction predicts post-transplant renal insufficiency. Campbell et al. 6 demonstrated that the duration of pretransplant Abbreviations: CI, confidence interval; CLKT, combined liver-kidney transplantation; INR, international normalized ratio; MELD, Model for End-Stage Liver Disease; N/A, not available; OR, odds ratio; RRT, renal replacement therapy; UNOS,

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“…47 Although more profound hyponatremia was found in those with complications including HRS, hepatic encephalopathy, and SBP, even a modest reduction in serum sodium levels (131-135 mEq/L) was associated with an increased rate of complications.…”

Section: Hyponatremiamentioning

confidence: 96%

“…In LT candidates, hyponatremia has been consistently associated with wait-list mortality 47 after MELD score adjustment and is most relevant in patients with a MELD score < 21. As a result, incorporation of serum sodium into MELD, Model for End-Stage Liver Disease-sodium (MELD-Na), increases prognostic accuracy.…”

Section: Hyponatremiamentioning

confidence: 99%

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

et al. 2015

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Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List

Cited by 1,212 publications

References 38 publications

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Pretransplant predictors of recovery of renal function after liver transplantation

Keeping high model for end‐stage liver disease score liver transplantation candidates alive

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